Submitted by Rob Cicoria, Consumer Advocate
The Medicaid funded Consumer-Directed Personal Assistant Program (CDPAP) began around 1970 in New York City, when disabled people who needed high-level care revolted against being involuntarily being put in nursing homes – – their civil rights to the pursuit of happiness were being infringed upon without due process. An amendment to the Nurse Practitioner Act allowed these disabled people to live outside of institutions with Personal Assistants (PAs) caretakers. Concepts of Independence (CI) became the first Fiscal Intermediary (FI) to provide this service. FIs do payroll, keep track of the paperwork and Medicaid mandated physicals. FIs also check for fraud by calling and making home-visits.
To qualify, the consumer must be self-directing, or have a designated representative, also known as a Surrogate, like a relative or friend, who is willing to hire, train, coordinate, and sometimes terminate the PAs. CDPAP allows the disabled and the elderly to mandate who comes into their home to do their care. A doctor’s letter of medical necessity as well as a nurse’s assessment is necessary before hours are granted. A Personal Assistant (PA), after being properly trained may perform personal care tasks or procedures which traditionally a nurse usually performs.
As a quadriplegic, I was with a certified agency for 26 years, and only learned about the program when I came to this job four years ago. After transferring my case to CI, I realized I had more freedom, because my PA could now drive me places I wanted to go – – no more relying on friends and family to do simple things like running errands. Also, I have a supra-pubic catheter that needs to be changed monthly. Often I waited in bed for a visiting nurse to come to do a procedure that literally takes ten minutes; now my PA is qualified to change the catheter at my convenience.
To qualify to be a PA a person must be 18 years or older, be legally qualified to work in the USA and pass a pre-employment health assessment to make sure they are free from any communicable diseases. An annual physical and a Tuberculosis Implant is required every year. 24 hours after the implant, the worker must return to have the implant read by a nurse; if positive, a chest x-ray is required to make sure the reading was a “false-positive.” However, the chest x-ray is valid for 10 years.
Under the new regulations a son or daughter may take care of a parent, as long as they do not live in the same dwelling. Also, extended family members are also eligible as long as they, once again, do not live in the same dwelling. A dwelling is defined as an apartment or house with a separate entrance, kitchen and bathroom. Unfortunately, parents cannot be paid for caring for their disabled children; spouses are exempt as well.